BACKGROUND AND PURPOSE:

• The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) found that while a single PSA screening test increased the number of prostate cancers, the test had no effect on prostate cancer mortality 10 years post-screening
• Martin et al. (JAMA Network Open, 2024) sought to determine whether a single PSA screening test reduced prostate cancer mortality 15 years post-screening

METHODS:

• Secondary analysis of CAP randomized trial
  • 8 hospitals across England and Wales
• Participants
  • Men aged 50 to 69
• Intervention
  • Invitation to a single PSA screening test, with subsequent diagnostic tests if the PSA level was 3.0 ng/mL or higher
  • Standard care
• Pre-specified secondary outcomes
  • Prostate cancer–specific mortality | All-cause mortality
  • Prostate cancer stage | Gleason grade at diagnosis

RESULTS:

• 415,357 men
  • Mean age 59.0 (SD, 5.6) years
• 15-year cumulative risk of prostate cancer
  • Screening: 7.08% (95% CI, 6.95 to 7.21)
  • Control: 6.94% (95% CI, 6.82 to 7.06)
• There was a slight but significant decrease in the number of deaths in the screening group
  • Screening: 0.69% (95% CI, 0.65 to 0.73)
  • Control: 0.78% (95% CI, 0.73 to 0.82)
  • Rate ratio (RR) 0.92 (95% CI, 0.85 to 0.99 | P=0.03
• Compared with the control, the PSA screening intervention increased detection of
  • Low-grade disease (Gleason score [GS] ≤6)
    • Screening: 2.2% | Control: 1.6% | P<0.001
  • Localized (T1/T2) disease
    • Screening: 3.6% | Control: 3.1% | P<0.001
• PSA screening had no effect on the detection rate of intermediate (GS of 7), high-grade (GS ≥8), locally advanced (T3), or distally advanced (T4/N1/M1) tumors
• There was no significant difference in all-cause deaths between the groups
  • Screening: 23.2% (95% CI, 23.0 to 23.4)
  • Control: 23.3% (95% CI, 23.1 to 23.5)
  • RR 0.97 (95% CI, 0.94 to 1.01) | P=0.11

CONCLUSION:

• A single PSA screening test modestly decreased the rate of prostate cancer specific mortality after 15 years of follow up
• There was no significant difference in all-cause mortality
• The authors state

In this secondary analysis of a randomized clinical trial, a single invitation for PSA screening compared with standard practice without routine screening reduced prostate cancer deaths at a median follow-up of 15 years

However, the absolute reduction in deaths was small

Learn More – Primary Sources:

Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial